As a measles outbreak in the United States shines attention on immunization, HPV stands out as the vaccine with chronically poor acceptance by the public.

No other vaccine encounters as much misinformation and parental fear.

“People talk about wishing there was a vaccine to prevent cancer. The HPV vaccine does that, but we fall short on getting people to use it. It’s frustrating,” said Dr. Gale Burstein, the Erie County health commissioner.

In Erie County, only about 30 percent of girls ages 13 to 17 complete the three-dose immunization regiment to protect against the human papillomavirus, the most common sexually transmitted infection. Niagara County’s rate is 28.5 percent.

The rates fall below the national average of 38 percent for girls – it’s 14 percent for boys – but exceeds other parts of New York State.

Federal officials have set a national goal of 80 percent coverage by 2020, saying tens of thousands of cases of cervical and other cancers could be prevented. The National Cancer Institute late last year invested $2.7 million at 18 cancer centers – including Roswell Park Cancer Institute – to boost the vaccination rates in their communities.

Those at Roswell Park will join efforts in Western New York to encourage parents to ask about the vaccine and doctors to do a better job of recommending it.

Some parents fear the vaccine will encourage their daughters to become promiscuous, even though a recent study offered more evidence on top of previous research that HPV vaccination does not increase unsafe sex among teen girls.

And anti-vaccination websites routinely make unsubstantiated claims about the vaccine’s safety and effectiveness.

“Too many people are getting their information from Dr. Google instead of their actual doctor,” said Dr. Martin Mahoney, a family physician and researcher who leads the HPV vaccination effort at Roswell Park.

Infection fighter

HPV is a group of more than 150 related viruses transmitted by skin-to-skin contact during sex. Most of the millions of people annually infected with HPV may never know it because the body’s immune system usually clears the infection. But some strains of the virus are linked to genital warts and cancer.

The virus causes most cervical cancer, as well as some oral, anal, vulvar, vaginal and penile cancers. For cervical cancer alone, the American Cancer Society predicts more than 12,900 new cases and 4,100 deaths this year in the United States.

Three HPV vaccines are available in the United States, each with different target groups and what they prevent.

The Food and Drug Administration in 2006 approved Gardasil by Merck for males and females ages 9 to 26 to prevent infection from four strains of HPV. In December, the FDA approved Gardasil 9, which protects against nine strains.

Gardasil prevents genital warts and anal cancers in both men and women, as well as cervical, vulvar and vaginal cancers in young women.

The FDA approved GlaxoSmithKline’s vaccine, Cervarix, in 2009 for protection against two HPV strains. It can only be used to prevent cervical cancer in females ages 10 to 25.

The Catholic Medical Association supports widespread – but not mandated – use of Gardasil for girls and women in the recommended age range “because it is effective, safe, and ethical to use, provided certain conditions are met,” according to the association’s position paper.

“Healing and preventing diseases, no matter what their source, are acts of mercy and a moral good,” according to the position paper. “Prevention of HPV infection is distinct from, and should not be construed as encouraging, the behavior by which HPV is spread.”

Sensitive issue

So why the resistance to the vaccine?

Parents cite some common reasons for not seeking the vaccine for their children, according to the journal Pediatrics, which analyzed data from the National Immunization Survey.

Their physicians did not recommend the HPV vaccine. Or their children were not sexually active. Parents also expressed concern over safety and side effects.

Concerns about safety grew each year in the report, from 4.5 percent of parents in 2008 to 16.4 percent in 2010.

Parental decisions not to vaccinate their children against HPV increased from 39.8 percent in 2008 to 43.9 percent in 2010.

That’s partly why so many children don’t start the vaccine series at the recommended ages of 11 or 12, before pre-teens become sexually active.

“It’s a very sensitive issue,” said Mahbubur Rahman, a University of Texas researcher who tracks HPV immunization rates. “Physicians are less likely to propose the vaccine to parents if a child is younger than 13. But a recommendation by a physician is the most important predictor of whether a parent will get their child vaccinated.”

Anti-vaccination groups cite data from the federal government’s Vaccine Adverse Event Reporting System to make the case that vaccines, including Gardasil, pose a concern. But anyone can make a report to the system about anything bad that happens after a vaccination even if it is unrelated to the vaccine.

In the case of the HPV vaccine, studies that examine adverse events have found no serious safety issues so far. The most common side effects include pain in the arm where the shot was given, mild fever and brief fainting.

Parental decision

Natasha Wagner’s daughter received the HPV vaccine last year after her pediatrician recommended it.

Wagner said she did her own homework on Gardasil.

“At first, I thought the vaccine was scary because others were scared,” the Williamsville mother said. “There is so much about vaccines in social media like Facebook that you can get overwhelmed by the possibilities. You can come to think you know more than a doctor.”

The vaccine’s benefits persuaded her.

“If there is a way to prevent cancer, why not do it?” she said.

Likewise, Kari Winter of East Amherst had her son vaccinated after wrestling with a general skepticism about medical science.

“I thought about the issues and made an informed decision,” Winter said. “Whatever the risk people imagine is countered by the overwhelming tragedy of sickness and death of not having vaccines.”

Doctor’s role

Researchers like Rahman, the University of Texas researcher, say the key to boosting the HPV vaccination rate depends on more pediatricians strongly recommending it as a normal part of immunizations and completing the three-dose regimen by offering shots whenever a child is in the office, not just for scheduled vaccinations.

The conversation with parents should focus on preventing cancer and not sex, they say.

Mahoney and his Roswell Park colleague Christy Widman are using their $150,000 grant to survey the Western New York medical community to create a status report on HPV vaccination and find places for improvement.

The funding represents the first major pot of money the National Cancer Institute has set aside to boost HPV vaccination, according to the researchers.

“We need to learn what it is now that we are doing that is not working and come up with an intervention,” said Mahoney, a professor of oncology at the cancer center.

For physicians, the optional HPV vaccine may be easy to pass on because schools require so many other immunizations for students.

Dr. Colleen Mattimore of Western New York Pediatrics said the neutral approach by some doctors on HPV vaccination may linger as a problem, but it will become less of a problem as more pediatric practices like hers adopt policies to encourage immunization with the vaccine.

Mattimore tells young patients the vaccine will protect them from a virus when they get older, and she allays parents’ fears by assuring them she has studied the science.

But she acknowledged boosting the vaccination rate may be a big challenge.

“Some parents don’t want to hear scientific explanations under any circumstances,” Mattimore said. “There is nothing you can say that will change their minds.”